Children (Please list all of your children even if they are not registered in the children's program):
Child 1:
*FirstLast

Birthday
MM/DD/YYYY

Does this child have allergies, if so please list them here.

Child 2:
FirstLast

Birthday
MM/DD/YYYY

Does this child have allergies, if so please list them here.

Child 3:
FirstLast

Birthday
MM/DD/YYYY

Does this child have allergies, if so please list them here.

Child 4:
FirstLast

Birthday
MM/DD/YYYY

Does this child have allergies, if so please list them here.

Child 5:
FirstLast

Birthday
MM/DD/YYYY

Does this child have allergies, if so please list them here.

Child 6:
FirstLast

Birthday
MM/DD/YYYY

Does this child have allergies, if so please list them here.

Have you participated in Moms (formerly known as MOPS) before?
*

YesNo

If yes, where?

How did you hear about Moms?
*

Home Church (if applicable):
*

Annual Membership Dues: $60 Total

The fee includes membership packet, devotion study book, crafts and activity supplies, and children's program supplies. The kids program is generously provided by First Baptist Maryville Preschool Department (Discovery Town).

Please make checks payable to FIRST BAPTIST MARYVILLE and submit it at the first Moms Meeting you attend.

Photograph Authorization Release

I give First Baptist Maryville Moms Group authority to photograph/videotape my child(ren) and myself during activities for the use on the Moms website page, Facebook, and/or promotional materials.